Objective: To evaluate the results of minimally invasive transapical aortic valve implantation (TAP-AVI) at one year follow-up.
Methods: 61 high risk patients with symptomatic aortic valve stenosis received TAP-AVI at our institution since 02/2006. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN™ THV, Edwards Lifesciences, Irvine, CA, USA) was used. All valves were implanted in a hybrid operative theatre under fluoroscopic and echocardiographic guidance. Patient age was 82.7 ±4.5 years, 79% were female, NYHA class was 3.4 ±0.5, previous cardiac surgery had been performed in eight patients, logistic EuroSCORE risk for mortality was 28.1 ±11.9% and STS score risk for mortality was 15.9 ±8.6%.
Results: TAP-AVI was performed successfully in 58 (95.1%) of the patients; three patients required early conversion due to proximal dislocation, secondary dissection of the aortic root and main stem occlusion. Two of the converted patients were discharged alive. A total of 73.7% of the patients were treated completely off-pump, secondary use of cardiopulmonary bypass was required in 3/39 (7.8%). 82% of the patients were extubated early after 80 ±17min. Echocardiography revealed good valve function; trivial to mild (1°), paravalvular incompetence was present in 41%. At thirty days four (6.6%) patients and during follow-up eight patients (15.3%) died, all with good valve function at most recent echo. Thirty day survival was 93 ±3.4%, six months survival 74.4 ±6.6% and one year survival 70.5 ±7.3%, respectively. There were no neurological events.
Conclusions: Transapical aortic valve implantation is a safe, minimally invasive and off-pump technique to treat high risk patients with aortic stenosis. One year results are good, especially when considering the overall risk profile of these patients.
Long term outcomes of patients with aortic structural valve deterioration treated with transcatheter valve in valve implantation